Characterization of aerosols generated during suspected aerosol-generating procedures in healthcare settings.

OBJECTIVE

To measure aerosol generation during various medical procedures that are potentially aerosol generating and determine whether these aerosols contain viral and/or bacterial pathogens that may pose a risk to healthcare personnel.

DESIGN

Observational.

SETTING

Tertiary care academic hospital.

PATIENTS: Convenience sample of adult patients undergoing one of the following procedures: extubation, bronchoscopy, mechanical ventilation, noninvasive ventilation, suctioning, nebulized medication administration (NMA), sputum induction, nasopharyngeal swab, or tracheostomy change.

METHODS

Four aerosol characterization instruments measured aerosol characteristics (particle mass, number, size); average baseline and procedure measurements were compared to identify changes in aerosolized particles associated with each type of procedure. SKC BioSamplers were used for viral and bacterial pathogen recovery. Clinical data were reviewed to examine patient characteristics that might impact pathogen recovery.

RESULTS

Among 93 sampled procedures, differences between baseline versus procedure measurements were only notable for NMA and sputum induction. Smaller increases in some particle measurements were observed for the single extubation sample. None of the 248 BioSampler specimens were positive for a respiratory virus, even though for 39 procedures, the patient had a recent clinical specimen that was positive for a respiratory virus. Thirty-two samples (13%) had positive bacterial cultures, all of which represented common skin/environmental contaminants or upper respiratory microbiota.

CONCLUSIONS

In this study, significant aerosol generation was only observed during NMA and sputum induction. No viral pathogens and minimal bacteria were recovered from these medically generated aerosols. These data suggest that some procedures that are considered "aerosol-generating" may pose little infectious risk to healthcare personnel.